Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, San Francisco, CA, 94143, USA.
Division of Interventional Radiology, Stanford University, Stanford, CA, USA.
Cardiovasc Intervent Radiol. 2022 Jul;45(7):972-982. doi: 10.1007/s00270-022-03103-4. Epub 2022 Mar 15.
To compare the cost-effectiveness of tunneled peritoneal catheter (TPC) versus serial large-volume paracenteses (LVP) for patients with recurrent ascites.
Retrospective, single-institution analysis of 100 consecutive patients undergoing LVP and eventual TPC placement (2015-2018) was performed with extraction of procedural complications and hospital admissions. LVPs were associated with 17 adverse events (AEs) while only 9 AEs occurred after TPC placement. While undergoing routine LVP, the patients had 30 hospitalizations monthly (177 days in total) and 10 hospitalizations monthly (51 days) after TPC placement. A cost-effectiveness analysis with Markov modeling was performed comparing TPC and LVP. Costs were based on Medicare reimbursement rates. Statistical analyses include base case calculation, Monte Carlo simulations, and deterministic sensitivity analyses.
TPC placement was the dominant strategy with a comparable health benefit of 0.08060 quality-adjusted life-years (QALY) (LVP: 0.08057 QALY) at a lower cost of $4151 (LVP: $8401). Probabilistic sensitivity analysis showed TPC was superior in 97.49% of simulations. Deterministic sensitivity analysis demonstrated the superiority of TPC compared to LVP if the TPC complication rate was < 9.47% per week and the complication rate for LVP was > 1.32% per procedure. TPC was more cost-effective when its procedural cost was < $5427 (base case: 1174.5), and remained as such when the cost of LVP was varied as much as $10,000 (base case: $316.48).
In this study, TPC was more cost-effective than LVP in patients with recurrent ascites due to the reduced risk of infection, emergency department visits, and length of hospitalization stays.
比较隧道式腹膜导管（TPC）与多次大体积腹腔穿刺术（LVP）治疗复发性腹水患者的成本效益。
对 2015 年至 2018 年间连续 100 例接受 LVP 并最终行 TPC 置管的患者进行回顾性单中心分析，提取手术并发症和住院情况。行 LVP 术的患者发生 17 次不良事件（AE），而 TPC 置管后仅发生 9 次 AE。行常规 LVP 术的患者每月有 30 次住院（共 177 天），TPC 置管后每月有 10 次住院（共 51 天）。采用 Markov 模型进行成本效益分析，比较 TPC 和 LVP。成本基于医疗保险报销率。统计分析包括基础情况计算、蒙特卡罗模拟和确定性敏感性分析。
TPC 置管为优势策略，其健康效益相当，为 0.08060 质量调整生命年（QALY）（LVP：0.08057 QALY），成本更低，为 4151 美元（LVP：8401 美元）。概率敏感性分析显示，在 97.49%的模拟中，TPC 更为优越。确定性敏感性分析表明，如果 TPC 并发症发生率<每周 9.47%，且 LVP 并发症发生率>每次操作 1.32%，则 TPC 优于 LVP。当 TPC 手术费用<5427 美元（基础情况：1174.5 美元）时，TPC 更具成本效益，当 LVP 成本变化高达 10000 美元（基础情况：316.48 美元）时，TPC 仍具有成本效益。
在这项研究中，与 LVP 相比，TPC 用于治疗复发性腹水患者具有成本效益，因为其感染、急诊就诊和住院时间的风险降低。
